This is a revised five-year application (1R01MH072386-01) by a new investigator in response to NIMH Program Announcement PA 04-075 "Mental Health Consequences of Violence and Trauma." This study is an efficacy trial, which is based on an NIMH small grant study (MH63643 PI, Gore-Felton) that was funded to develop and pilot test a human immunodeficiency virus (HIV) risk reduction intervention for adults who are living with HIV and are experiencing trauma-related stress symptoms. Our central premise is that by first treating trauma symptoms, we will enhance the effects of a skills-building HIV risk reduction intervention for adults experiencing trauma-related symptoms. To this effect, the PI has developed an innovative group intervention based on a model that proposes trauma-related symptoms have direct effects on HIV risk behavior. Thus, the successful treatment of trauma-related symptoms will facilitate HIV risk behavior change. The proposed study will be a randomized efficacy trial in San Mateo, CA. A total of 270 HIV-positive adults who report experiencing a traumatic stressor, report engaging in HIV risk behavior in the past 3 months, and report experiencing trauma-related stress symptoms in the past three months will be randomly assigned to one of three study groups: (1) standard HIV risk reduction intervention (n = 90); (2) standard HIV risk reduction + trauma-focused stress reduction intervention (n = 90); or (3) standard of care, wait list (n = 90). The research will be guided by the distress model and social cognitive theory. The specific aims of the proposed study are: a) to determine if decreasing trauma-related stress improves HIV risk reduction behavior above a standard HIV risk reduction intervention alone; b) to determine whether key variables (i.e., demographic & psychosocial) moderate the intervention's effects; and c) to determine whether there is evidence that the theoretical mediator variables mediate the intervention's effect on outcomes. The public health implications of this research are significant because few studies have examined the efficacy of risk reduction interventions among HIV positive individuals and as individuals with HIV are living longer, the threat of secondary infections increases. If successful, this proposal will improve our ability to decrease HIV transmission and increase mental health functioning among populations that are being hit hardest by the HIV/AIDS epidemic. [unreadable] [unreadable] [unreadable]